ISSUE SLIP STAPLE AREA (for additional cross references)
POSITION
INITIALS
ID NO.
DATE
FEE DETERMINATION
O.I.P.E. CLASSIFIER
FORMALITY REVIEW
y*> ^
RESPONSE FORMALITY REVIEW
INDEX OF CLAIMS
^ Rejected N Non-elected
= ' Allowed I Interference
- (Through numeral)... Canceled A Appeal
Restricted 0 Objected
a.
0*
Claim
Date
Claim
Date
Clai
m
1
Date
i
E Q fcl
r T>7 I "
- J- /
Final
Original
Final
Onglnal
EJu
51
1
01
J J
2
52
02
3
53
03
4
54
104
5
55
1
05
>
56
06
57
107
J
58
toe
)
59
109
0
-
60
110
61
111
— \ A
1 !
62
112
13
63
113
11
64
114
1 >
65
115
1 I
66
116
1 '
67
-
117
1 I
68
118
n "
i
69
119
— ^
70
i
120
71
121
t ^
72
122
ii "
73
123
74
124
75
125
26
/ V >/
76
126
77
127
28
78
128
29
79
129
30
80
130
31
61
131
32
82
132
33
83
133
34
84
1£W
85
135
. u ■
86
13€
: 7
87
137
: J
88
13e
39
\/
89
13S
90
14C
)
91
14
1
42
92
u:
3
43
93
14;
2
44
9/
I
14^
1
45
95
14*
46
\
9€
14f
47
97
14
7
48
9£
14J
3
49
9S
)
14
£
50
10
0
15
0
If more than 150 claims or 10 actions
staple additional sheet here
(LEFT INSIDE)